{
  "reporting_entity_name" : "Baylor Scott & White Health Plan",
  "reporting_entity_type" : "HMO",
  "last_updated_on" : "2026-11-01",
  "version" : "2.0.0",
  "out_of_network" : [ {
    "name" : "OFFICE/OUTPATIENT VISIT EST",
    "billing_code_type" : "CPT",
    "billing_code_type_version" : "2026",
    "billing_code" : "99214",
    "description" : "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.",
    "allowed_amounts" : [ {
      "tin" : {
        "type" : "ein",
        "value" : "75-2510007"
      },
      "service_code" : [ "20" ],
      "billing_class" : "professional",
      "setting" : "outpatient",
      "payments" : [ {
        "allowed_amount" : 135.25,
        "providers" : [ {
          "billed_charge" : 334.00,
          "npi" : [ 1770048704 ]
        } ]
      } ]
    } ]
  } ]
}